Poor immunization coverage causes of outbreaks across Nigeria- ED

Dr Faisal Shuaib is the Executive Director of the National Primary Health Care Development Agency (NPHCDA). In this interview he speaks on Nigeria’s progress to being certified polio-free and its struggles with Routine Immunization

By Ruby Leo

Tell us some of the most striking findings of the 2016 survey on Routine immunization coverage and its relations with the transparency tenets of this administration

In 2016 the multiple indicator surveys for the national immunization coverage survey revealed that only one quarter of children in Nigeria have been vaccinated with the appropriate vaccines for their ages. When you look at a specific antigen, the pentavalent three as an indicator of the coverage only 33% of children in Nigeria have received penta three vaccines at the time they are supposed to get the vaccines. That is a far cry from the minimum of the 80% that is expected to build population immunity against vaccine-preventable diseases, of course these are survey results which are not unusual or suddenly new to Nigeria, but a different coverage survey that has shown that in the last few decades we are not doing a good enough job when it comes to covering our children with the vaccines.

But in the past, governments have turned down the survey results despite methodologists that indicate they followed global world standards, and instead a lot of reliance was made on the administrative coverage, that is to say that the coverage that health workers were fling in their reports. We now had coverage figures of over 90% and sometimes over a 100%, so there was a lot of data falsification, but with the advent of this administration, we realized that the methodology that was used to conduct this survey were global standard and that they were accurate.

So we went ahead and accepted the result. And we said that yes we know that the routine immunization coverage was poor, but apart from being this poor, there was also evidence to show that because the coverage was poor, we were having outbreak of diseases.

You are aware of the fact that year in year out we have outbreak of measles, meningitis, yellow fever, a clear indication that we were not vaccinating the children the way we are supposed to be vaccinating them. We did accept these results as a true reflection of the coverage figures of Nigeria, and we declared a state of public health concern around this low immunization coverage. We went ahead to set up a National Emergency Routine Immunization centre at the National level, also replicated same at the state level, and the local government to underscore the fact that we need better coordination of routine immunization activities to improve routine immunization coverage.


Is that what brought about the NERICC, SERICC and LERICC?

Absolutely, at the National level we have the National Emergency Routine Immunization Coordinating Centre, at the State we have the State Emergency Routine Immunization Coordinating Centre and the Local Emergency Routine Immunization Coordinating Centre.


 How far has these strategies improved routine immunization?

There has been a direct colorations between the set up of these centres and the improvement in the routine immunization coverage, so for example starting from the last quarter of 2017, we did a base line assessment of the routine immunization coverage using what we call the lot quality assurance sampling method, which is really a gold standard in industries to test the quality of different lots. We would go to the settlement to assess how our kids are being vaccinated, see how many kids have been vaccinated, and to see if there are evidence to show that these kids were actually vaccinated, and we have seen a progressive increase in the number of kids that have been vaccinated, and a progressive number of local government areas all over the country that are been accepted as having adequate number of kids that have been vaccinated. So we are actually seeing a trajectory that give us course to be excited about the interventions that we are applying all across the country.


How close are we to being declared a polio free country?

We are properly 10 months away if we do not report any case of a wild polio virus during the period, and the certification committee from the World Health Organisation review the data and the samples that we have sent out and does a holistic review of the programme, and it is determined that there is zero chances of wild polio virus transmission of course the processes for the certification of Nigeria as having eradicated polio will now be activated. So we feel pretty optimistic that this is exactly what will happen, that we will actually be declared polio free in the next few months, given that we have now gone over 25 months without a single case of wild polio virus.

Usually if a country goes three years without reporting a single case of wild polio virus and there is evidence and surveillance ongoing to search for the wild polio virus and none has been identified then, these are the grounds for considering that the country has really eradicated polio, so now we are at 25 months.


What is the progress of the revitalization of 10,000 Primary Health Care centre with the objective of making it one centre functional

From the beginning we knew that it was not possible for only the federal government to accomplish, it was never intended to be a federal government activity, it was always a partnership between the federal government, state, NGOs, donors and the private sector. Right now based on the count, as many as 4000 primary health care centres have been renovated, a lot of states have identified one primary health care centre per ward that they are actually renovating or have completed renovating. We are hopeful that in the next few years we would be able to have in each ward a single health centre that has been renovated in terms of revitalization, like having the right human resources, the right equipment, making sure that there is 24 hour service, so that women don’t come in the middle of the night to deliver babies and there is no service.

 The centre should have electricity, water, drugs available to be given. This is really tied into the basic health care provision fund which the president will be launching in the next few weeks. So it is going to be such that having identified the functional primary health care centres per ward, they will have direct funding from the basic health care provision fund, the funds will be transferred from the Central Bank nationally all the way to the health facilities directly so that they have funds to procure drugs, fix the infrastructure, hire health workers within that locality based on their needs.

This removes the bureaucratic red tape that is involved in getting funds from the national level, the funds goes directly to the health facilities so they become their own masters. The officer of the facility is now a chief executive officer of the health facility and they ensure proper accountability for all funds that are generated and access the performance management of the health staff. They ensure that the quality of health care services that are provided in the health care services is of the highest possible quality, such that Nigerians are treated with compassion when they go to the health facility and with dignity and respect. These are some of the interventions that President’s Buhari administration is trying to ensure, that when people go to the health centres, and they are treated very well, apart from that they do not incur any out of pocket expenditure that will tilt them into poverty.

But with the basic health care provision fund, we have a situation now where working with the fund and the National Health Insurance Scheme, people do not have to pay from their pocket, the health care services is provided practically free for vulnerable groups such as children under five years of age, women within the reproductive age group for antenatal services.

The fund which would be launched soon by the president, is of great importance to Nigerians and would be a huge legacy of the President Buhari’s administration. We are excited that finally that Nigerians would have access to basic health care services without breaking the bank.


Finally tell us about the GAVI and Nigeria’s MOU on the $3b joint investment on immunization and GAVI’s extension of stay in Nigeria till 2028

Based on the original agreement plan with GAVI, Nigeria is supposed to transit out of GAVI support in 2021, but we have looked at the immunization space, the primary health care space, identified all the challenges that we have and we concluded that without GAVI support, not just financial, but technically it would be difficult for us to meet some ambitious goals we have set out in the sustainable development goals. We had a conversation and negotiation with GAVI for an extension of that transition period to 2028. So now we have a robust plan and strategy for how we can improve primary health care, immunization in the course of the next ten years.

With over $1.03b contribution from GAVI and the federal government of Nigeria contributing domestic resources to the tune of over $1.9b, that is what brings it to the $3b. We have established an accountability framework to ensure that those funds are used judiciously, transparently, equitably, used to improve immunization and strengthen primary health care in a way that ensures that 10 years down the line we don’t go cap in hand asking for an extension of the GAVI transition period or asking for support from donors. So we want to strengthen the health care system in such a way that future generations of Nigeria’s can now build on a solid foundation. 

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